Endometriosis is a disease that affects 1 in 10 menstruators between ages 15 and 49. At its most basic description, and in terms of reproductive health, it is a chronic, systemic disease where the growth of endometrial-like tissue is outside of the uterus. This tissue can grow in various places beyond the pelvis. For example, in other organs such as: your bowels, kidneys, liver, and in severe cases, even in your lungs, brain and sinuses. Throughout the stages of the menstrual cycle, the endometrial-like tissue potentially acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. It can cause issues ranging from ovarian cysts (endometriomas) to implants throughout the pelvis and body and contributes to infertility.

The cause is mostly unknown and unfortunately, it is not preventable. There are several ‘theories’ about causes, but no certain explanation. What we do know, however, is that it’s an inflammatory condition meaning, the immune system is involved, and it responds to hormonal fluctuations. So, addressing inflammation is a significant factor for ongoing treatment.

Cure rates have been posted around 50% with combination surgery and endocrine medications but were also tied to a second surgery. However, endometriosis is very treatable. Some mild-moderate cases can be largely treated by addressing the inflammation and hormones. Many people with mild endometriosis may go their whole lives without even knowing they had it. Other potential treatments or strategies of mitigation that can be useful (in combination) to manage the pain are: Surgery Hormone therapy Heating pads Pain killers TENS Unit A change in diet

In Dr. Bala’s practice, she treats her patients with period pain and endometriosis similarly. Regardless of the diagnosis of endo or not, the treatment would likely address the inflammation and hormones first. In particular, elevated estrogen levels (which can potentially worsen period pain) and high levels of prostaglandins which are main factors of primary dysmenorrhea (aka period pain). Dr Tassone is one of the few endometriosis experts in the country that employs excisional surgery, hormonal balance, and anti-inflammation with diet, exercise, and supplements.

Common symptoms include: abnormal or irregular periods, painful periods, painful bowel movements and urination, painful sex, fatigue, bowel habit changes, nausea and vomiting with your period, or ther symptoms based on the location of the implants. Remember that period pain is NOT normal so if you are experiencing any of these symptoms, check in with your doctor!

There is a genetic predisposition for endometriosis. There are also environmental and epigenetic factors; a small percentage of endometriosis is hereditary.

This is hard to say because it feels different for everyone! But generally, endo warriors experience pain ranging from mild to severe with timing from a few days before the cycle to well into the cycle. Endometriosis does not correlate to the amount of pain. Stage 1 can be very painful and some with Stage 4 have no idea.

If YOU are someone working through endometriosis symptoms, we would absolutely love to hear from you. Consider joining our Inner Cycle community to have your voice and experiences heard and understood by a welcoming community of both menstruators and non-menstruators!

There are 4 stages: minimal, mild, moderate, severe and are diagnosed surgically. The stage of endometriosis is based on the: location, amount, depth and size of the endometrial tissue. It involves the extent of the spread of the tissue, how much of the pelvic organs are involved, how much pelvic adhesions there are, and blockage of the fallopian tubes. As stated above, the stages don’t necessarily reflect how much pain the person may experience. Adhesions are the result of inflammatory reactions forming a band between the organs and are more like scar tissue. "Lesions" are the patches of endometriosis tissue itself.

Your OB/GYN may do a pelvic exam, ultrasound, MRI, and/or laparoscopy. Though, as stated, if you haven't had surgery (aka the laparoscopy) endometriosis is only suspected.

The unfortunate thing about endometriosis is that getting the diagnosis is difficult. It requires surgical excision and tissue diagnosis to confirm diagnosis due to the added challenge that you can’t determine if it’s endometriosis solely based on imagery. Gynecologic surgeons are the ones making this definitive diagnosis, so if you haven't had surgery, endometriosis can only be suspected.

If it’s a deep implant or is causing an ovarian cyst you may be able to, although it depends on sizes and depths of invasion. But in milder cases, diagnosis with ultrasound may prove difficult.

This is something that we talked about during our IG Live with Dr. Bala which you can watch here. About 75% of people with endometriosis can achieve pregnancy. Severe endometriosis can have adhesions and may cause issues with the fallopian tubes. Removing the endometrial lesions is possible and should be done by an experienced surgeon, but new implants could grow back. Another piece is estrogen – if estrogen metabolism is a bit skewed, that can also affect reproductive abilities. Dr. Bala made it clear that it’s not as clear cut as “you have endo, which automatically means you’ll have trouble getting pregnant”.

Not directly. But excess inflammation and excess hormones (like estrogen) may cause weight gain.

Unfortunately yes, they’re not mutually exclusive (aka they can be experienced at the same time).

According to Dr. Bala, no it cannot.

Giving birth for the first time after 30 Never being pregnant Family history Immune disorders Structural abnormalities of uterus/tubes Heavy bleeding Short cycles (less than 27 days) Bleeding for more than 7 days at a time However, these are different depending on where you look and the body of the patient.

Postmenopausal endometriosis is a bit more complex than premenopausal endometriosis since it’s still unclear as to whether or not it’s due to recurrence, due to a continuation of a previous disease, or due to a de novo condition. Excess estrogen, in general, is associated with endometriosis. As menopause occurs, estrogen production levels change in the ovaries which should also be considered.

It’s likely more prevalent than we as doctors are even aware of. It can take approximately 4-11 years to get the diagnosis. In part, due to misdiagnosis but also due to the fact that confirmation is done through surgical excision so younger people may be negated from proper diagnosis and treatment.

If you have a period that’s regular, relatively pain free, not too heavy, and with no other symptoms, then you only need to go in for pelvic exams and “well woman” exams. During these visits they may do cervical cancer screenings.

Thank you for taking the time to read this and educate yourself on endometriosis. Although March is Endo Awareness Month, we need to spread reliable information all year around. More research needs to be done to fully understand the complexity, and full-body effects that this systemic disease has on people. If you are struggling with severe period pain yourself, or any of the listed symptoms, we definitely recommend checking in with your doctor!